Moon Seong Cheol, Cho Nam Su, Rhee Yong Girl
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
Am J Sports Med. 2015 May;43(5):1099-107. doi: 10.1177/0363546515570030. Epub 2015 Feb 10.
Coracoid transfer to a large glenoid defect is considered an excellent method to restore the surface area of the anteroinferior glenoid. However, there is little quantitative evidence supporting whether a coracoid graft can sufficiently restore the glenoid arc.
To assess whether the Latarjet procedure can sufficiently restore the surface area of the glenoid.
Case series; Level of evidence, 4.
A total of 44 patients who underwent a Latarjet operation for a large glenoid defect between February 2009 and July 2011 were enrolled in this study. Three-dimensional computed tomography was used to calculate the surface areas of the preoperative glenoid defect size and the reconstructed glenoid. Preoperative and postoperative clinical results also were assessed.
At the last follow-up, the mean visual analog scale score for instability during motion improved significantly from 5.1 points (range, 3-10 points) preoperatively to 1.3 points (range, 0-4 points) (P<.001). The mean deficit in external rotation at the side, external rotation at 90° of abduction, and internal rotation to the posterior were 10°±20°, 7°±16°, and 1.9°±4°, respectively (P=.004, .022, and .009, respectively). The overall recurrence rate was 4.5% (2 of 44 shoulders). The mean preoperative glenoid defect size was 157±38 mm2 (range, 141-239 mm2; 25.3%±6% of the intact glenoid surface). The mean surface area of the coracoid graft used for reconstruction was 152±34 mm2 (range, 146-236 mm2; 24.8%±5% of the intact glenoid surface). After the Latarjet procedure, the mean surface area of the reconstructed glenoid was 706±32 mm2 (range, 639-749 mm2). Finally, postoperative glenoid defect size was 5±11 mm2 (range, 3-28 mm2; 1.5%±2% of the intact glenoid surface).
The Latarjet procedure can provide satisfactory outcomes, including a low recurrence rate and reliable functional recovery. Defects at the anteroinferior glenoid were restored to nearly normal after coracoid transfer by use of the Latarjet procedure, which is an anatomically matched reconstruction.
喙突转移至巨大肩胛盂缺损处被认为是恢复肩胛盂前下方表面积的一种极佳方法。然而，几乎没有定量证据支持喙突移植能否充分恢复肩胛盂弧度。
评估Latarjet手术能否充分恢复肩胛盂的表面积。
病例系列；证据等级，4级。
本研究纳入了2009年2月至2011年7月期间因巨大肩胛盂缺损接受Latarjet手术的44例患者。采用三维计算机断层扫描计算术前肩胛盂缺损大小和重建后肩胛盂的表面积。同时评估术前和术后的临床结果。
在最后一次随访时，运动时不稳定的平均视觉模拟评分从术前的5.1分（范围3 - 10分）显著改善至1.3分（范围0 - 4分）（P <.001）。患侧外旋、外展90°时外旋以及内旋至后方的平均缺失分别为10°±20°、7°±16°和1.9°±4°（分别为P =.004、.022和.009）。总体复发率为4.5%（44个肩关节中有2个）。术前肩胛盂缺损的平均大小为157±38 mm²（范围141 - 239 mm²；占完整肩胛盂表面的25.3%±6%）。用于重建的喙突移植的平均表面积为152±34 mm²（范围146 - 236 mm²；占完整肩胛盂表面的24.8%±5%）。Latarjet手术后，重建肩胛盂的平均表面积为706±32 mm²（范围639 - 749 mm²）。最后，术后肩胛盂缺损大小为5±11 mm²（范围3 - 28 mm²；占完整肩胛盂表面的1.5%±2%）。
Latarjet手术能提供满意的结果，包括低复发率和可靠的功能恢复。通过Latarjet手术进行喙突转移后，肩胛盂前下方的缺损恢复至接近正常，这是一种解剖学匹配的重建。
